Endoscopy 2013; 45(12): 1032-1034
DOI: 10.1055/s-0033-1344855
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions

Mathieu Pioche
1   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices civils de Lyon, France
2   Inserm U1032, LabTau, Lyon, France
,
Laetitia Mais
1   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices civils de Lyon, France
,
Olivier Guillaud
1   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices civils de Lyon, France
,
Valérie Hervieu
3   Pathology Unit, Edouard Herriot Hospital, Hospices civils de Lyon, France
,
Jean-Christophe Saurin
1   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices civils de Lyon, France
,
Thierry Ponchon
1   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices civils de Lyon, France
2   Inserm U1032, LabTau, Lyon, France
,
Vincent Lepilliez
1   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices civils de Lyon, France
› Author Affiliations
Further Information

Publication History

submitted 19 January 2013

accepted after revision 23 July 2013

Publication Date:
28 October 2013 (online)

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Background and study aim: Endoscopic submucosal dissection (ESD) is recommended for en bloc R0 resection of superficial esophageal neoplasms larger than 20 mm, but is high risk and time-consuming. In the tunnel technique, incisions at the lower and upper lesion edges are joined by a submucosal tunnel and then lateral incisions are made. The mucosa is thereby easily separated from the muscular layer. We report our experience of esophageal tunnel ESD.

Patients and methods: We retrospectively reviewed all consecutive esophageal tunnel ESDs performed at our unit between January 1 2010 and January 11 2013. Lesions were superficial esophageal neoplasms, UT1N0 at EUS. 

Results: 11 patients underwent tunnel ESD (nine squamous cell carcinomas, two adenocarcinomas). Mean dissected surface area was 13.25 cm². Mean procedure duration was 76.7 minutes. All 11 resections were en bloc and 9 /11 were R0. Complications were one subcutaneous emphysema with spontaneous resolution, and stenosis in 4 /11 patients (36.4 %) with resolution after 1 – 5 dilations.

Conclusion: Tunnel ESD of superficial esophageal neoplasms is an interesting option, seeming to be faster and more effective than standard ESD, without higher morbidity.